Self Care 2025: Nausea, Vomiting, and Diarrhea

Common Causes of Nausea/Vomiting

-Motion sickness,

-"Morning sickness,"

-Acute viral enteritis,

-Indigestion (dyspepsia)

-"Upset stomach"

What are some common complications of Nausea/Vomiting

Dehydration

Electrolyte Imbalances

Signs and Symptoms of Dehydration in Children

-Restlessness or Irritability

-Rapid or deep breathing

-Tachycardia

-Dry mouth and tongue

-Sunken and/or dry eyes

-Sunken fontanelle

-Decreased urine output (dry diapers for several hours)

-Dark Urine

-Thirst (drinks extremely eagerly)

-Absence of tears when crying

-Decreased skin turgor

-Prolonged capillary refill in the fingertip after release of a gentle squeeze

-Weight loss

Treatment goals for Nausea/Vomiting

-Provide symptomatic relief

-Identify and correct underlying cause

-Prevent and correct complications

-Prevent future occurrences

Exclusion for Self-treatment for Nausea/Vomiting

-Urine ketones and/or high BG with signs of dehydration in patients with diabetes

-Suspected food poisoning that does not clear up after 24 hours

-Severe abdominal pain in the middle or RLQ

-N/V with fever and/or diarrhea

-Severe RUQ pain, esp after eating fatty foods

-Blood in the vomitus

-Yellow skin or eye discoloration

-Stiff neck with or without headache and sensitivity to brightness of normal light

-Head injury with N/V, blurry vision, or numbness and tingling

-Persons with glaucoma, BPH, chronic bronchitis, emphysema, or asthma (may react adversely to OTC antiemetics)

-Pregnancy (severe symptoms) or breastfeeding

-N/V caused by cancer chemotherapy; radiation therapy; serious metabolic disorders; CNS, GI, or endocrine disorders

-Drug-induced N/V: adverse effects of drugs used therapeutically (opioids, NSAIDs, antibiotics, estrogens); toxic doses of drugs used therapeutically (digoxin, theophylline, lithium); ethanol

-Psychogenic-induced N/V: bulimia, anorexia

-Chronic disease-induced N/V: gastroparesis with diabetes, DKA or HHS with diabetes, GERD

Non-pharm for Nausea/Vomiting

-Commercial oral rehydration solutions (ORS) recommended to prevent/correct dehydration

-NOT sports drinks

-Offer 10 minutes after last vomiting episode

4 Non-pharm steps for Morning Sickness

1. Keep something in the stomach (crackers)

2. Avoid strong smells

3. Avoid heat, humidity

4. Identify and avoid food triggers

What is the purpose of ginger in morning sickness?

For pregnancy, motion sickness, surgery

What are some ADRs and precautions for ginger?

-ADRs: Heartburn, Belching, Discomfort

-May have anticoagulant properties, do not recommend to patients taking warfarin

What is the purpose of Vitamin B6 for morning sickness?

May be useful in pregnancy

What are some ADRs of Vitamin B6?

Possible ADRs: Neuropathy, Weakness, Lethargy, Nystagmus if used high dose or long term

Non-Pharm for Motion Sickness

-Avoid reading

-Look out windshield

-Avoid excess alcohol

-Choose seat of least motion

-Avoid strong odors

Treatment for Motion Sickness

1st generation Antihistamines

-Meclizine

-Diphenhydramine

-Dimenhydrinate

What are some ADRs of the 1st gen Antihistamines?

-Dry mouth, confusion, constipation

-Children may have paradoxical effects

-Older adults may have increased ADRs

Presentation of diarrhea

-Viral: 24-48-hour onset, may be accompanied by vomiting, fever

-Foodborne can be detected through tracking food intake 48-72 hours

-"Self-limiting"

-Mild-moderate = 3-5 unformed (watery) stools/day

What are some common medications that can cause diarrhea?

-Alpha-glucosidase inhibitors

-Antibiotics

-Cholinergic agents

-Antiretroviral therapy

-PPIs

-SSRIs

Treatment goals for Diarrhea

1.Prevent or correct fluid and electrolyte loss and acid-base disturbance

2.Control symptoms

3.Identify and treat the cause

4.Prevent acute morbidity/mortality

Exclusions for Self-Treatment for Diarrhea

-Young age (<6 months or weight <17.5 lbs)

-Persistent fever (+100.4 F for patients <3 months; +102.2 for patients 3+ months)

-Visible blood, pus, or mucus in stool

-High output, including frequent and substantial volumes of diarrhea

-Persistent vomiting

-Signs of severe dehydration

*Children showing behavioral/mental changes (irritability, apathy, lethargy, unconscious)

*Children who have not urinated in 8 hours

*Children who have no tears when crying

*Orthostatic hypotension

-Severe abdominal pain/distress: tenderness, distention

-Risk for significant conplications, including chronic medical conditions or concurrent illness

*Diabetes, severe CVD, renal disease

*Immunosuppressed patients (e.g. from cancer chemotherapy, organ transplantation, AIDS), frail patients 65+ yrs

-Pregnancy

-Chronic or persistent diarrhea

-Suboptimal response to ORS already administered

Non-Pharm for Diarrhea

Rehydration is the MAIN treatment

-Oral rehydration solutions should be recommended for mild to moderate diarrhea

-Sports drinks MAY be appropriate in mild diarrhea, IF another source of sodium is used

What should a patient's diet look like with diarrhea?

Eat normally

-BRAT diet not recommended

-Avoid fatty foods, sugary foods and drinks

What are some precautions for Loperamide?

-ADR: Dizziness, Constipation

-CYP 450 drug interactions, not generally clinically significant

-Be cautious of misuse and abuse

-Use in > 6 years old only

-Not for bacterial diarrhea

What are some precautions with Bismuth Subsalicylate

-Use in > 12 years old only

-Do NOT use within 6 weeks of varicella or influenza vaccine

-Do NOT use in patients taking aspirin, or those who are aspirin allergic, taking tetracycline, or medicine for gout

-Tinnitus is a dose-related adverse effect

-May be used to prevent traveler's diarrhea, but should not be used concomitantly with antibiotic treatment

What is the purpose of Lactase Enzymes in Diarrhea?

Prevent osmotic diarrhea in people intolerant to lactose

Key Points for Pharm therapy for Diarrhea

1. Treat kids <5 yrs with ORS only, keep a supply on hand

2. Counsel patients on ORS

3. BSS not for kids/adolescents

4. Maximum time to treat: 48 hours

5. REFER ALL older adults (65 yrs)

6. REFER all pregnant women